SAN ANTONIO -- A prospective, randomized study comparing external
beam radiotherapy with radical prostatectomy for localized prostate
cancer found no clear winner in terms of quality of life during the 2
years after treatment, Savino M. Di Stasi, M.D., said at the annual
meeting of the American Urological Association.

Overall health-related quality of life declined in the first month
and returned to baseline in 6-12 months regardless of therapy, said Dr.
Di Stasi of Tor Vergata University, in Rome. During the first month,
patients receiving radical prostatectomy reported a significantly worse
quality of life, compared with patients receiving external beam
radiotherapy (EBRT).

The study involved 137 men, 96 of whom were evaluated at 1, 3, 6,
12, and 24 months. The investigators used an Italian language version of
the Functional Assessment of Cancer Therapy-General (FACT-G), a
validated quality-of-life instrument.

Significant differences between the groups appeared in three FACT-G
subtests, those measuring urinary, bowel, and sexual function.

In terms of urinary function, radical prostatectomy was
significantly worse than EBRT for the entire follow-up period, with 11%
of men in the radical prostatectomy group and 3% of men in the EBRT
remaining incontinent at 2 years.

On the other hand, radical prostatectomy beat EBRT in terms of
bowel function. At 2 years, 92% of men in the radical prostatectomy
group, compared with 73% of men in the EBRT group, reported bowel
function.

Sexual function was significantly better in the EBRT group than in
the radical prostatectomy group just after treatment. However, the EBRT
group showed a modest but statistically significant decline in sexual
function over 2 years, whereas the radical prostatectomy group improved
over time. At the end of the follow-up period, sexual dysfunction
remained more common in the radical prostatectomy group than in the EBRT
group (70% vs. 61%).

In spite of the fact that neither treatment showed a clear
advantage in terms of quality of life, Dr. Di Stasi's impression is
that most patients would choose EBRT because "many patients prefer
noninvasive treatment if possible."

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